一种儿童阻塞性睡眠呼吸暂停综合征临床预测模型的建立

A clinical prediction model for pediatric obstructive sleep apnea syndrome

目的:构建并验证一种简易的儿童阻塞性睡眠呼吸暂停综合征(OSAS)临床预测模型。方法:筛选多导睡眠监测(PSG)95例2~12岁儿童患者的临床数据,根据阻塞性呼吸暂停低通气指数(OAHI)≤1分为非OSAS组(n=22),OAHI>1为OSAS组(n=73),收集并对比两组的性别、年龄、体质指数(BMI)、夜间最低脉搏血氧饱和度(SpO_(2))、扁桃体分级及腺样体分度情况,并对上述变量进行研究,采用二元Logistic回归分析法对数据进行统计分析,建立儿童OSAS临床预测模型。结果:OSAS组患者的年龄、BMI、夜间脉搏最低血氧饱和度(SpO_(2))、扁桃体分级、腺样体分度等指标与非OSAS组比较,均有显著性差异(P<0.05),性别无显著性差异;模型方程为:X=2.366-0.769(年龄-连续变量)+0.248(BMI-连续变量)-3.413(SpO_(2)-连续变量)+2.104(扁桃体分级为Ⅲ~Ⅳ级“是”);Hosmer-Lemeshow检验为P=0.612(P>0.05),内部验证的AUC为0.821(0.713-0.929,P<0.01),敏感度为83.3%,特异度为76.4%;外部验证的准确度为73.8%,AUC为0.805(0.664-0.943,P<0.01),敏感度84.6%,特异性为75%。结论:该预测模型对2~12岁儿童的阻塞性睡眠呼吸暂停综合征可能有较好的预测效能,可辅助临床医师诊断儿童OSAS。

Objective:To establish and verify a simple clinical prediction model for obstructive sleep apnea syndrome(OSAS)in children.Methods:The clinical data of 95 children aged 2-12 years underwent polysomnography(PSG)were screened.The subjects with OAHI≤1 were included into non-OSAS group(n=22)and those with OAHI>1 into OSAS group(n=73).Gender,age,body mass index(BMI),night pulse minimum oxygen saturation(SpO_(2)),tonsil grading and adenoid grading of the 2 groups were compared and analyzed.Binary Logistic regression analysis was used to statistically analyze the data and establish a clinical prediction model for OSAS in children.Results:There was significant difference in age,BMI,SpO_(2),tonsil grading and adenoid grading between the 2 groups(P<0.05),there was no significant gender difference(P>0.05).The model equation was as follows:X=2.366-0.769(age-continuous variable)+0.248(BMI-continuous variable)-3.413(SPO_(2)-continuous variable)+2.104(tonsil gradeⅢ-Ⅳ“yes”).The result of internally validated Hosmer-Lemeshow test was P=0.612(P>0.05),AUC was 0.821(0.713-0.929,P<0.01),sensitivity was 83.3%,specificity was 76.4%.The accuracy of external validation was 73.8%,the AUC was 0.805(0.664-0.943,P<0.01),the sensitivity was 84.6%and the specificity was 75%.Conclusion:The predictive model may have good predictive efficacy for 2-12 years old children with OSAS,and may assist clinicians in diagnosing children with OSAS.